Abstract
Participant recruitment and retention, as well as community engagement, are vital to the success of clinical trials, yet they are often approached as procedural rather than relational processes, limiting meaningful interaction between researchers and participants. This paper explores these dynamics as part of a broader initiative assessing knowledge and practice of the Good Clinical Trials Collaborative (GCTC) Guidance among clinical trial stakeholders in South Africa. A convergent parallel mixed-method design was adopted, with this paper focusing on the qualitative component. Purposeful sampling was used to recruit 22 key informants, including clinical trial researchers, regulatory specialists, implementation scientists, and administrative personnel. Data were analysed using thematic analysis to identify patterns and thematic structures, supported by NVivo 15 software for coding, organisation, and retrieval of qualitative data. Findings indicate that effective community engagement is often hindered by poor communication, language barriers, low research literacy, and historical mistrust stemming from past ethical breaches, contributing to misunderstandings and reduced participation. Participants highlighted the importance of transparency, including trial registration and the provision of clear, accessible information, as well as improved, contextually appropriate communication strategies to build trust, facilitate informed consent, and enhance participation. The study underscores persistent challenges related to communication and trust that affect recruitment, retention, and engagement. Addressing these challenges requires transparent, ongoing, and inclusive communication approaches that are sensitive to linguistic and cultural diversity. Strengthening relational, community-centred practices and aligning recruitment and engagement with GCTC Guidance principles are essential for promoting equity, inclusivity, and the conduct of high-quality clinical research in diverse settings such as South Africa.